New Study Points to Promising Way to Protect Kidneys in Type 1 Diabetes

For people living with Type 1 diabetes, kidney disease is one of the most serious long-term threats. The damage can develop quietly over time, as high blood sugar slowly injures the tiny blood vessels that filter waste from the body. By the time symptoms appear, kidney disease may already be well underway. Researchers have long searched for new ways to slow that process, and a new international study suggests one promising approach.

Richard E. Pratley, M.D., senior investigator and diabetes program lead at the AdventHealth Translational Research Institute (TRI), served as one of the lead researchers on the international FINE-ONE clinical trial, which examined whether a medication called Finerenone could help protect kidney health in people with Type 1 diabetes.

The trial, published in The New England Journal of Medicine, followed 242 adults with Type 1 diabetes and chronic kidney disease. Researchers found that participants taking Finerenone experienced a 34 percent reduction in protein leaking into the urine, an early sign of kidney damage, compared with a 12 percent reduction in those receiving a placebo. The evidence suggests the medication may help slow the progression of kidney disease when used alongside standard therapies.

“Over the last century, there have been many important developments in insulin therapy that have allowed patients with type 1 diabetes to live long lives—in many cases five to six decades with the disease,” said Dr. Pratley. “But this long duration of diabetes puts stress on the kidneys that, over time, can lead to chronic kidney disease in up to 30 to 40 percent of people.”

Why This Matters

Kidney disease often begins silently. One of the earliest warning signs is albuminuria, or protein leaking into the urine. When the kidneys are damaged, they lose their ability to filter proteins from the bloodstream, allowing them to pass into the urine instead.

Reducing that leakage is important because it signals that the kidneys may be under less stress. In many studies, lower levels of albuminuria have been linked to slower progression of kidney disease.

Finerenone works by blocking the mineralocorticoid receptor, a pathway involved in kidney inflammation and scarring. By targeting this mechanism, researchers believe the medication may help protect kidney tissue from further damage.

“Finerenone is unlike other medications for treating kidney disease in diabetes in that it doesn’t target blood sugar,” Dr. Pratley explained. “It specifically decreases the inflammation and scarring in the kidney that leads to chronic kidney disease. In the FINE-ONE trial, Finerenone appeared to be very safe and well tolerated.”

Looking Ahead

The study also evaluated safety. Overall, the medication was well tolerated, though researchers observed elevated potassium levels in some participants, a finding physicians would monitor closely if the drug becomes more widely used.

Researchers also observed a small early change in kidney filtration rate (eGFR) in people taking Finerenone. This type of temporary change is commonly seen with medications that affect kidney blood flow.

Although the results are encouraging, researchers say more studies will be needed. The FINE-ONE trial followed participants for six months, and longer research will be required to determine whether the medication can reduce major outcomes such as kidney failure or the need for dialysis.

“We have seen in patients with type 2 diabetes that Finerenone also decreases the risk for heart disease—probably through a similar mechanism,” said Dr. Pratley. “This makes me optimistic that, in addition to having kidney benefits, Finerenone might also decrease the risk for heart disease in patients living with type 1 diabetes.”

For now, experts emphasize that managing blood sugar, blood pressure, and cholesterol is important. But studies like FINE-ONE offer hope that new therapies may soon expand the options available to help protect kidney health for people living with Type 1 diabetes.